Westminster Hall Debate, The Healthy Start Scheme, 22 May 2024

Healthy Start is an NHS scheme that provides additional cash support to the lowest-income families with children under 4 years old, and pregnant and breastfeeding women, to buy milk, fruits, vegetables, pulses, and vitamins. Money is provided to families on a pre-paid card that can only be spent on authorised items.

Children and young people

21 May 2024

Key Messages

• Adequate nutrition in the first months and years of a child’s life is critical to support their healthy development. In recent years, the health of children under five has stalled or declined across various measures, including infant mortality, childhood obesity, tooth decay and mental health. Declining health outcomes are linked to a rise in poverty, with children from disadvantaged areas significantly more likely to face a range of poor health outcomes compared to those in more affluent areas.

• The Healthy Start scheme, which provides additional cash to spend on healthy food and milk (via a pre-payment card) to pregnant women and children under 4 in the lowest-income families, plays a vital role in ensuring the most disadvantaged infants and children have access to healthy food. We want to work with the Government to expand and improve the scheme so that it can play an even greater role in reversing negative trends in children’s health, as part of wider action to address poverty and health inequalities.

• Healthy Start has suffered from persistently low uptake rates and is failing to reach all eligible children. The Government’s latest figures show that over 200,000 eligible low-income families – the equivalent to the population of Norwich – are not claiming support. Over the last year, the national uptake rate has dropped further from 64.8 percent in April 2023 to 62.5 percent in April 2024.

• Parents are required to make an online application to access the scheme, which reduces uptake among people who are digitally or socially excluded. Low awareness of the scheme and an overly complex application process are also key barriers. The LGA has long been calling on Government to implement a straightforward automatic enrolment process for all eligible families. This could be easily achieved through data sharing between the Department of Work and Pensions (DWP) and the NHS Business Services Authority.

• To ensure that no child has their health and life chances impacted by food insecurity in the first years of life, we are calling for the Government to:

Develop a nationwide communications campaign to boost awareness and uptake of the scheme. This should include working with retailers to label Healthy Start items in shops.
Uplift the value of Healthy Start in line with current inflation and commit to review the value of the scheme every six months. Payments have been frozen at £4.25 per week since 2021, significantly decreasing their value.
Expand the scheme to all families on Universal Credit to ensure more families facing food insecurity can access support.
Expand the scheme to families with children aged five and under. This would bridge the current gap in nutritional support between Healthy Start, which ends at the age of four, and Free School Meals, which begins when children start school at the ages of four and five.

Background

Introducing auto-enrolment of Healthy Start

In September 2022, the Government placed a target on the NHS to increase uptake of Healthy Start to 75 per cent. This has not yet been achieved, with uptake declining in the last year. Barriers to uptake include a lack of parental awareness about the scheme, restrictive eligibility requirements, too few retailers accepting the card, the low monetary value of the scheme and the online application process, which reduces applications from those who are digitally excluded. LGA analysis found that families who spoke English as an additional language and those who felt less confident in their money management skills were less likely to access the scheme.

Many councils, such as Durham, have worked to proactively improve uptake through public awareness-raising campaigns, engagement with parents via community and public health services, and targeted, data-driven communications to low-income families. These campaigns have been successful in improving uptake – in some areas by up to 10 per cent – particularly among families with children with special educational needs and disabilities. Despite these efforts, no area has been able to register above 75 per cent of eligible children.

We are therefore calling for the DWP to work with the NHS to simplify this process by automatically registering all eligible families, using DWP Universal Credit data. This is the most effective and efficient approach to ensuring every eligible child and pregnant mother receives the support they are entitled to.

Expanding the eligibility

Children are eligible for Healthy Start if their parents receive Universal Credit and earn less than £408 a month, excluding benefits. The current eligibility criteria, therefore, excludes many children who are facing food insecurity. The £408 threshold has not been updated since 2016. This means that the number of eligible children is decreasing year on year due to inflation; the number of eligible children from April 2023 to April 2024 dropped by 2.8 per cent.

Moreover, as Healthy Start ends when a child turns 4 years old, there is a gap in the nutritional support disadvantaged children receive until they start school and access free school meals, at 4 or 5 years old.

We are therefore calling for the scheme:

To be expanded to all families on Universal Credit to better encompass all children facing food insecurity.
To be expanded to children up to the age of five.

Increasing the value

In April 2021, Healthy Start payments were increased to £4.25 a week (for pregnant women and children aged 1-4), up from £3.10. Mothers with babies aged from birth to their first birthday receive £8.50 a week. The value has since been frozen at 2021 levels, despite record levels of food inflation. For example, since April 2021, the cost of milk has increased by 50 per cent (at March 2024 prices), significantly reducing the real terms value and purchasing power of Healthy Start.

We are therefore calling for Government to uplift the value of Healthy Start in line with current inflation. This should be followed by a review of the scheme every 6 months to increase costs in line with inflation.

Labelling Healthy Start items

We would welcome the Government working with retailers to label Healthy Start items at the point of purchase in shops and supermarkets. This could have multiple benefits, including raising awareness of the scheme among parents and prompting awareness of healthier food options.

Contact: Megan Edwards, Public Affairs and Campaigns Adviser, [email protected]